Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Case report
Year : 2021 | Month : August | Volume : 15 | Issue : 8 | Page : OD15 - OD17 Full Version

Co-infection of SARS-CoV-2 with Dengue Fever-A Case Report


Published: August 1, 2021 | DOI: https://doi.org/10.7860/JCDR/2021/49440.15291
Shreya Reddy Singireddy, Swamy Miryala, Srikrishna Raghavendra Boddu, Suresh Inugurthi

1. Junior Resident, Department of General Medicine, Kamineni Academy of Medical Sciences and Research Centre, Hyderabad, Telangana, India. 2. Professor, Department of General Medicine, Kamineni Academy of Medical Sciences and Research Centre, Hyderabad, Telangana, India. 3. Assistant Professor, Department of General Medicine, Kamineni Academy of Medical Sciences and Research Centre, Hyderabad, Telangana, India. 4. Associate Professor, Department of General Medicine, Kamineni Academy of Medical Sciences and Research Centre, Hyderabad, Telangana, India.

Correspondence Address :
Dr. Srikrishna Raghavendra Boddu,
1-2-234/11, HarshaKrishna Villa, New SBH Colony, Gaganmahal Domalguda, Hyderabad-500029, Telangana, India.
E-mail: krishna030@gmail.com

Abstract

The current pandemic circulation of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) along with Dengue Virus (DENV) in disease endemic countries may produce unfavourable circumstances with co-infection, delays in emergency mitigation measures and management of the disease as both the viral diseases have many similar close characteristics and presentations. This is a case report of a 50-year-old diabetic and hypertensive female admitted with complaints of fever with chills for one week duration. On initial evaluation due to the ongoing pandemic as per the protocol, the patient was found negative with rapid antigen testing for SARS-CoV-2, Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) test along with negative High-Resolution Computed Tomography (HRCT) of the chest. Basic initial investigations suggested decreased platelet count and elevated acute phase proteins. Two days after admission, the patient was found to be Dengue IgM and IgG positive and the patient’s symptoms were managed accordingly. Later, the patient suddenly showed decrease in oxygen saturations and warranted a ventilator immediately. The CT pulmonary angiogram was done to rule out suspected pulmonary thromboembolism, which was showing infective lesions with Coronavirus disease 2019 Reporting and Data System grade 4 (CO-RADS 4). Repeat RT-PCR for SARS-CoV-2 was positive. The Patient was immediately shifted to high isolation Intensive Care Unit (ICU) and treated according to the Standard Operating Protocol (SOP) of SARS-CoV-2 infection. The overlapping clinical presentations of SARS-CoV-2 infection and DENV in resource-constrained settings and the complexities of interpreting results make identification of SARS-CoV-2 in the dengue endemic areas difficult. Therefore, a high degree of alertness should be maintained for SARS-CoV-2 infection in DENV endemic areas.

Keywords

Coronavirus disease-2019, Endemic areas, High suspicion, Severe acute respiratory syndrome coronavirus-2, Viral infections

Case Report

A 50-year-old female presented to the emergency with complaints of fever and breathlessness since three days. According to her medical history, she was suffering from controlled Diabetes Mellitus Type 2 which was diagnosed a year back and was kept under control by lifestyle modification along with metformin (biguanide). She was also diagnosed with hypertension five years earlier and was on regular medication with telmisartan (Angiotensin Receptor Blocker). The patient was having an oxygen saturation of 92% at room air which increased to 96% when 2 litres oxygen/min was administered. As part of hospital emergency SOP in a patient with acute febrile illness and breathlessness, she was tested for SARS-CoV-2 by rapid antigen testing and HRCT chest to look for any radiological findings suggestive of the disease. The RT-PCR test was also done which takes considerable time for the result. However, both the Rapid antigen test card and HRCT chest were negative for viral infection with CO-RADS grading reported as 2. All routine investigations including cultures along with serologies suspecting a possible Acute Febrile Illness (AFI) were conducted. The patient was put in an observation ICU, monitoring oxygen requirement with empirical treatment.

The following day patient was found to be symptomatically better requiring minimal intermittent oxygen therapy and was also found to be RT-PCR negative for SARS-CoV-2 infection. However, routine investigations including Total leucocyte count, Platelet count and Packed Cell Volume (PCV) (Table/Fig 1) were suggesting a picture of viral disease with thrombocytopenia and blanching rash. Investigations pertaining to DENV were done. Dengue Non-Specific Antigen 1 (NS-1) was negative on the admission day and IgG and IgM Dengue serologies were reported to be positive.

The patient was started with IV fluids as the initial management and later treated according to the laboratory parameters along with monitoring of decreased platelet count. Further investigations were done which revealed elevated D-dimer levels (Table/Fig 1) for which the patient was started on injectable anticoagulant Clexane (Enoxaparin). The patient was also started on doxycycline (antibiotic) for its property of inhibiting dengue virus serine protease thereby decreasing the replication of the virus. Lactate Dehydrogenase (601 U/L) and Alkaline Phosphatase levels (689 IU/L) are the other elevated parameters found in the initial workup, indicating the presence of an infection. The patient was treated based on the laboratory reports and was shifted to a step down ICU. Both the blood and urine cultures were sterile. On Day 5 of admission around noon patient suddenly started showing decreased oxygen saturation and was immediately warranted endotracheal intubation. Arterial blood gas analysis (Table/Fig 1) was suggesting respiratory acidosis. The patient also complained of chest heaviness at that time though the cardiac leads were showing normal sinus rhythm with a pulse rate of 97 beats per minute with a blood pressure of 140/96 mm of Hg.

Pulmonary thromboembolism (PTE) was suspected, and immediate CT pulmonary angiography was done for the patient (Table/Fig 2) which revealed the patient to be negative for PTE, but it showed pulmonary oedema and infection changes with CO-RADS staging 4. Repeat RT-PCR for SARS-CoV-2 was done which was positive on the same day. The patient was immediately shifted to a high isolation ICU and anticoagulants were continued along with the initiation of SOP for COVID-19 (SARS-CoV-2 infection). The patient was started on antiviral medication Remdesivir (200 mg IV stat on the first day followed by 100 mg IV once daily for four days) and Methyl Prednisolone (0.5 mg/kg. body weight). The patient was continued on antibiotics and supportive constitutional treatments including antitussives, analgesics, proton pump inhibitors and multivitamin supplements along with monitored hydration. After four days according to the improvement of symptoms, the patient was weaned off of the ventilator, extubated, shifted to step down ICU and later shifted to the wards. After a total of 16 days of admission, the patient was discharged and sent home with detailed medical advice including awake prone positioning as done during the treatment, low dose prophylactic anticoagulants (Eliquis 2.5 mg once a day for 10 days), pulse oximeter monitoring at home and asked to follow-up in two weeks.

Follow-up was remarkably fair with no new symptoms and the patient was instructed to continue taking safety precautions and also get vaccinated.

Discussion

According to WHO, globally, as of 7th June 2021, there have been 172,956,039 confirmed cases of COVID-19 (SARS-CoV-2) infection which includes 3,726,466 deaths and the numbers were still on the rise. As of 4th June 2021, a total of 1,900,955,505 vaccine doses had been administered (1). The global burden of COVID-19 infection has been presumed to be the worst of all the pandemics to date. Most patients experience mild to moderate respiratory illness and recover without any specific treatment. The severe disease forms have been seen with significant risk factors that include advanced age and co-morbidities. The presentation and clinical history are similar in almost all viral diseases. Dengue is one of the most common vector-borne endemic disease and it continues to be a difficult disease to manage, especially during the COVID-19 pandemic. A similar case was reported wherein the patient presented with symptoms concerning an AFI with seven days history admitted in an isolation and found to be having mild positivity on rapid antigen tests for dengue virus which was later confirmed through polymerase chain reaction to being DENV Serotype 2. Also, the patient was found to be positive for RT-PCR for SARS-CoV-2 at the same time and supportively treated according to the symptoms of the disease (2).

On the contrary, the patient in this case report was found to be negative for all the possible parameters indicative for SARS-CoV-2 infection initially along with positive serologies for dengue virus infection accompanied by early findings of thrombocytopenia and mild leucopenia or lymphopenia. The patient was treated according to the symptoms and was even considered for platelet transfusions in case she starts to bleed, or the platelet count drops further below 46,000/cu.mm noted at the time of admission (Table/Fig 1). The patient was given all possible care in a different isolation ICU (Non COVID-19) from the start after triaging removing the scope of infectivity from other patients or fomites transfer. Patient laboratory parameters suddenly changed on the 5th day of admission, overwhelming the management with respiratory acidosis, changing the neutrophil-lymphocyte ratio indicating the severity of infection with lymphopenia (Table/Fig 1).

The risk of dengue infection exists in 129 countries, and it is endemic in more than 100 countries. Around 70% of the actual burden of disease is in Asia (3). One modelling estimate indicates 390 million global dengue virus infections per year (95% CI 284 to 528 million), of which 96 million manifests clinically (4),(5). The COVID-19 pandemic continues to spread worldwide, and it is likely to overlap with the dengue epidemics in tropical countries. Due to overlapping clinical and laboratory features, it may be difficult to distinguish dengue from COVID-19 (3).

Laboratory diagnosis of COVID-19 with underlying infection by DENV is a greater challenge. Some reports have revealed false positive dengue antibodies in COVID-19 patients who were misdiagnosed as dengue (6),(7),(8). Also, serological cross-reactivity is very commonly seen between viral diseases and it has been reported (9),(10). The role of special serological tests such as the Plaque Reduction Neutralisation Test (PRNT) for dengue should be considered for accurate and better diagnosis though it may serve a different purpose in testing. It is considered to be the “gold standard” to characterise and quantify circulating levels of anti-DENV Neutralising Antibody (NAb) thereby can indirectly give a better perspective of the diagnosis in the situation (11). Also, testing for both dengue and COVID-19 with standard principles and proper isolation of suspected cases after triaging looks promising and ideal which is already being practised in institutes and universities in other countries. Though it is a tedious process, it is the ideal procedure, taking into consideration the time and space constraints.

Conclusion

The COVID-19 should be included in the differential diagnosis of AFI even if another infection has already been found. A strategy for precise diagnosis including many direct and indirect tests for the identification of the infection will help in minimising the time taken for management. Precautionary and prophylactic isolation of patients with AFI should be considered to prevent the spread of infection. Multi-sector differential strategies in proper prevention for both diseases should be integrated to solve this problem.

References

1.
World Health Organization. Coronavirus disease (COVID-19) outbreak situation.Available: Https://www. who. int/ emergencies/ diseases/ novel- coronavirus- 2019 [Accessed 7 June 2021].
2.
Nasomsong W, Luvira V, Phiboonbanakit D. Case report: Dengue and COVID-19 co-infection in Thailand. Am J Trop Med Hyg. 2021;104(2):487. [crossref] [PubMed]
3.
Wee LE, Cherng BPZ, Conceicao EP, Goh KCM, Wan WY, Ko KKK, et al. Experience of a tertiary hospital in Singapore with management of a dual outbreak of COVID-19 and dengue. Am J Trop Med Hyg. 2020;103(5):2005-11. [crossref] [PubMed]
4.
World Health Organization. Dengue and severe dengue, 2020. Available: Https://www. who. int/ news- room/ fact- sheets/ detail/ dengue- and- severe- dengue [Accessed 23 Aug 2020].
5.
Bhatt S, Gething PW, Brady OJ, Messina JP, Farlow AW, Moyes CL, et al. The global distribution and burden of dengue. Nature. 2013;496(7446):504-07. [crossref] [PubMed]
6.
Chen N, Zhou M, Dong X. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet. 2020;395:507-13. [crossref]
7.
Ratnarathon AC, Pongpirul K, Pongpirul WA, Charoenpong L, Prasithsirikul W. Potential dual dengue and SARS-CoV-2 infection in Thailand: A case study. 2020;6(6):e04175. [crossref] [PubMed]
8.
Tiwari L, Shekhar S, Bansal A, Kumar P. COVID-19 with dengue shock syndrome in a child: Coinfection or cross-reactivity? BMJ Case Reports CP. 2020;13(12):e239315. [crossref] [PubMed]
9.
Brady OJ, Gething PW, Bhatt S, Messina JP, Brownstein JS, Hoen AG, et al. Refining the global spatial limits of dengue virus transmission by evidence-based consensus. PLoSNegl Trop Dis. 2012;6:e1760. [crossref] [PubMed]
10.
Lustig Y, Keler S, Kolodny R, Ben-Tal N, Atias-Varon D, Shlush E, et al. Potential antigenic cross-reactivity between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and dengue viruses. Clin Infect Dis. 2020;2:01-06. [crossref] [PubMed]
11.
Thomas SJ, Nisalak A, Anderson KB, Libraty DH, Kalayanarooj S, Vaughn DW, et al. Dengue plaque reduction neutralization test (PRNT) in primary and secondary dengue virus infections: How alterations in assay conditions impact performance. Am J Trop Med Hyg. 2009;81(5):825-33. Doi: 10.4269/ajtmh.2009.08-0625. PMID: 19861618; PMCID: PMC2835862. [crossref] [PubMed]

DOI and Others

10.7860/JCDR/2021/49440.15291

Date of Submission: Mar 15, 2021
Date of Peer Review: May 03, 2021
Date of Acceptance: Jul 14, 2021
Date of Publishing: Aug 01, 2021

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jun 25, 2021
• Manual Googling: Apr 30, 2021
• iThenticate Software: Jul 31, 2021 (9%)

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